基于证据的、由护士主导的移植相关血栓性微血管病早期预警模型及医疗质量改进项目的开发与实施：一项混合方法的前后对照研究
Development and implementation of evidence-based, nurse-leading early warning model and healthcare quality improvement project for transplant-associated thrombotic microangiopathy: a mixed-methods, before-and-after study.
作者信息
Zhou Xiaoyu, Ye Yishan, Jin Aiyun, Pan Zhengwen, Xu Zhe, Ding Shuyi, Yan Jiali, Cheng Yin, Huang Yixuan, Cao Kai, Xie Wei, Zhang Jianli, Xu Liwei, Zhou Weiwei, Huang Lihua
机构信息
Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medical, Hangzhou, China.
Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medical, Hangzhou, China.
出版信息
BMC Nurs. 2024 Aug 7;23(1):535. doi: 10.1186/s12912-024-02093-7.
OBJECTIVE
The early identification and diagnosis of transplant-associated thrombotic microangiopathy (TA-TMA) are essential yet difficult in patients underwent hematopoietic stem cell transplantation (HSCT). To develop an evidence-based, nurse-leading early warning model for TA-TMA, and implement the healthcare quality review and improvement project.
METHODS
This study was a mixed-methods, before-and-after study. The early warning model was developed based on quality evidence from literature search. The healthcare quality review and improvement project mainly included baseline investigation of nurse, improvement action and effectiveness evaluation. The awareness and knowledge of early parameter of TA-TMA among nurses and the prognosis of patients underwent HSCT were compared before and after the improvement.
RESULTS
A total of 1 guideline, 1 evidence synthesis, 4 expert consensuses, 10 literature reviews, 2 diagnostic studies, and 9 case series were included in the best evidence. The early warning model including warning period, high-risk characteristics and early manifestation of TA-TMA was developed. The improvement action, including staff training and assessment, suspected TA-TMA identification and patient education, was implemented. The awareness and knowledge rate of early parameter of TA-TMA among nurses significantly improved after improvement action (100% vs. 26.7%, P < 0.001). The incidence of TA-TMA was similar among patients underwent HSCT before and after improvement action (2.8% vs. 1.2%, P = 0.643), while no fall event occurred after improvement action (0 vs. 1.2%, P < 0.001).
CONCLUSION
The evidence-based early warning model and healthcare quality improvement project could enhance the awareness and knowledge of TA-TMA among healthcare providers and might improve the prognosis of patients diagnosed with TA-TMA.
目的
在接受造血干细胞移植（HSCT）的患者中，移植相关血栓性微血管病（TA-TMA）的早期识别和诊断至关重要但却困难重重。旨在建立一个基于证据、由护士主导的TA-TMA早期预警模型，并实施医疗质量审查与改进项目。
方法
本研究为混合方法的前后对照研究。早期预警模型基于文献检索的高质量证据构建。医疗质量审查与改进项目主要包括护士基线调查、改进措施及效果评估。比较改进前后护士对TA-TMA早期参数的知晓情况以及HSCT患者的预后。
结果
最佳证据共纳入1项指南、1项证据综合、4项专家共识、10篇文献综述、2项诊断研究和9个病例系列。建立了包括TA-TMA预警期、高危特征和早期表现的早期预警模型。实施了包括人员培训与评估、疑似TA-TMA识别及患者教育在内的改进措施。改进措施实施后，护士对TA-TMA早期参数的知晓率显著提高（100%对26.7%，P<0.001）。改进措施前后接受HSCT的患者中TA-TMA的发生率相似（2.8%对1.2%，P=0.643），而改进措施实施后未发生跌倒事件（0对1.2%，P<0.001）。
结论
基于证据的早期预警模型和医疗质量改进项目可提高医护人员对TA-TMA的认识和知识水平，并可能改善TA-TMA确诊患者的预后。
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